Home Health Nursing Feels the Greatest Pinch from the Nursing Shortage

By Glenna Murdock, RN, contributor

The nursing shortage is not imaginary and is a growing problem. Department of Labor statistics support the projection that in the next 10 to 15 years the shortage will reach a crisis level as the demand for nurses far exceeds the supply. And, the sector that looks to be most seriously affected by the ever-worsening shortage is that of home health care nursing.

In July 2008 the Visiting Nurses Association of America (VNAA) conducted a survey of its non-profit members to determine the effects of the current shortage on those agencies. Those responding to the survey reported an average 10 percent vacancy rate in registered nurse positions and 59 percent of respondents reported having to turn down client referrals each week due to staffing shortfalls.

Looking ahead to 2016 and beyond, the Department of Labor is projecting greater growth of registered nurse jobs within the home health sector (39.5 percent) than in the hospital sector (21.6 percent). Longer life spans within an expanding aging population and an increase in chronic disease among that demographic contribute to the expected higher demand for home health care nurses. Due to these factors, it is likely that by 2016 home health care will be experiencing an approximate shortage of 39 percent fewer nurses than needed.

Beyond numbers and statistics, Visiting Nurse Agencies (VNA) must contend with the problem of graduating nurses leaving nursing school having had little, if any, preparation for working in home health care. The additional training that must be provided to new nurses hinders the productivity of the existing staff and creates a need for more field nurses. A cycle of fixing one problem only to lead to the creation of another is the result.

Kathy Bibelheimer, RN, AA, is a 16-year veteran of home health nursing. As the assistant director of nursing for Caring Hearts Home Health in Greeley, Colorado, she knows firsthand the time investment required to prepare a nurse to feel comfortable and competent for solo home visits.

“Orientation varies somewhat, based on the nurse’s experience,” Bibelheimer explained. “We want nurses to have at least one year of hospital experience prior to our hiring them. We use several hours of video training and match them one-on-one with experienced nurses for actual home visits. We augment those training methods with weekly case conferences that guide new nurses in the way things should be done. In addition, I spend from four to six hours with each new nurse focusing solely on the many facets of Medicare, particularly the detailed documentation that is essential for Medicare reimbursement. It takes six months, at the very least, for a nurse new to home health to feel truly comfortable working alone.”

Non-profit VNAs, that historically carry the burden of providing a larger amount of uncompensated care, are further challenged by the fact that growing case loads result in diminished funds for attracting nurses with offers of competitive salaries and benefit packages. Again, the vicious circle effect.

As a means of combating the dire possibilities of inadequate staffing, VNAA supports legislation that is expected to be introduced in Congress in the near future entitled The Home Healthcare Nurse Promotion Act. The new administration has made national health care a priority and for the next two years will focus heavily on solutions for the plethora of health care problems that face the nation.

This investment in health care reform, according to the VNAA, must place workforce concerns in a position of utmost importance. To that end, the VNAA urges home health nurse advocates to be organized, vocal and persistent in putting the sector’s issues at the forefront and keeping them there.